Two recent papers have addressed evolution in our knowledge of the impact of androgen deprivation therapy (ADT) on various mental aspects of the health of patients with prostate cancer and their partners as well.

In the first of these two papers, Donovan et al. offer a detailed review of the psychological effects and impact of ADT on individual patients, their partners, and their relationships over time, with a particular focus on such factors as the increasing evidence of emotional lability and depressed mood in men who receive ADT and the risk of depression in patients’ partners. They also address emerging evidence of the onset, over time, of cognitive effects suggesting that ADT is associated with impairment in multiple cognitive domains.

The review also looks into data on the effectiveness of various types of intervention intended to mitigate the psychological effects of ADT. Donovan and her colleagues conclude that, at this time, physical exercise seems to have the greatest potential to address the psychological effects of ADT — not just in the patients themselves, but in their partners as well.

In a second paper, Van Dam et al. report the results from a relatively large, on-line survey conducted among prostate cancer patients who were or were not being treated with ADT (n = 295) and some of the partners of such patients (n = 84). The survey was designed to investigate such matters as the patients’ current moods and their moods prior to treatment, relationship adjustment, and sexual function. Data from men being managed on ADT were compared to data from men who received non-hormonal treatments for their cancer.

Van Dam et al. were able to show that:

Men currently receiving treated with ADT (n = 82) reported worsened mood compared to those not on ADT (n = 213).

The negative impact of ADT on mood was lower in older patients.

Partners of men on ADT (n = 42) reported similar declines in the patient’s mood to those reported by patients themselves, but to a higher degree than the levels reported by the patients.

The authors conclude that, based on their data:

ADT does have significant impact on the mood of prostate cancer patients.

That patients’ partners are, commonly, well aware of these effects.

That the psychological changes associated with use of ADT can impact relationships and affect the quality of life of patients and of their and partners as well.

That both patients and their partners would probably benefit from early and appropriate guidance and education about the likely psychological effects of ADT on men starting such therapy.

Now there is nothing particularly “stunning” in either of these papers. A high percentage of men who have been treated with long-term ADT — for whatever reason — may have experienced effects like those just described, as may their partners.

On the other hand, what these papers do do is help to expand the ground base of scientific literature on the psychological (as opposed to just the physical) effects of ADT and what we may be able to do to help patients and their close family members live with or live through these experiences.

No. The review and the survey encompass all sorts of different types of ADT. There are indeed differences, but those differences can vary wildly by patient and by type of ADT.

One of the points that the authors are making is that far too many physicians (and not just urologists) are not good about ensuring that their patients understand the potentiol for these types of psychological effect when they start patients on ADT.

I see it as being extremely important that physicians prescribing androgen deprivation medications provide a thorough explanation of the side effects that “might” (not necessarily will) be experienced by the patient as well as explaining those side effects to the spouse/partner of the patient. So far, the physician community has not been trained in providing such counseling, or a sufficient amount of such counseling. Knowing in advance what might occur is an advance salve for the acceptance by individuals as such events occur. Lack of advance awareness has been much of the cause of the adverse psychological effect when side effects present themselves.

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